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Less invasive options effective for treating adenomyosis

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Ultrasound-guided high-intensity focused ultrasound (HIFU) ablation and the levonorgestrel intrauterine system (LNG-IUS) offer less invasive options for treating women with symptomatic adenomyosis, according to 2 reports in the November 10th Fertility and Sterility online.

The standard therapy for symptomatic adenomyosis, which is thought to affect 1% of women, is hysterectomy. Other proven alternatives include hysteroscopic endometrial resection (for women with minor symptoms) and uterine artery embolization.

Dr. Liang-Dan Tang and colleagues from Chongqing Medical University, Chongqing, People’s Republic of China report their experience with HIFU ablation in a single-center study of 78 women, age 26 to 48 years, with symptomatic adenomyosis.

Twenty-seven women (39.1%) experienced complete relief of their dysmenorrhea symptoms, another 26 (37.7%) had significant relief, and 9 (13.0%) had partial relief. None had an exacerbation of dysmenorrhea after the ablation.

Eight (13%) of the 62 women with clinically effective results experienced relapses (6 at 6 months and 2 at 12 months after treatment).

Mean scores for menorrhagia and dysmenorrhea were significantly improved at both 3-month and 18-month follow-up.

The extent of nonperfused tissue on enhanced MRI correlated with the clinical outcome, but did not predict the occurrence of a relapse.

Twenty-two women (28.6%) had a total of 27 complications, 23 of which required no treatment. There were no severe adverse events, extended hospitalizations, or readmissions associated with treatment.

Based on these findings, the researchers conclude “that ultrasound-guided HIFU ablation may be a safe and effective noninvasive alternative in the treatment of symptomatic adenomyosis.”

In a second study, Dr. Ozlem Ozdegirmenci from Etlik Zubeyde Hanim Women’s Health Teaching and Research Hospital, Ankara, Turkey and colleagues compared the effects of LNG-IUS versus hysterectomy on efficacy and quality of life in a prospective study of 75 women with adenomyosis diagnosed by transvaginal ultrasound and MRI.

LNG-IUS insertion was performed in 43 women without anesthesia, patient discomfort, or complications. Hysterectomy in 32 women was performed via the abdominal route, and only 1 woman experienced complications (postoperative wound infection).

Among the women who underwent LNG-IUS insertion, 10 (23.8%) were amenorrheic at the end of 6 months and 22 (51.4%) were amenorrheic after 12 months. Eighteen women (42.8%) had oligomenorrhea at 6 months, and 15 (35.7%) had oligomenorrhea at 12 months.

Except for one device expelled spontaneously, the devices remained in place at the end of the first year, for a continuation rate of 97.7%. No woman requested removal of the device.

The most common side effects of LNG-IUS were headache (11.9%), breast tenderness (7.1%), acne (4.8%), and transient depressive episode (2.4%).

Serum hemoglobin levels increased after LNG-IUS insertion and after hysterectomy, and women in both groups experienced improvements in quality of life scores. Women treated with LNG-IUS reported improvement in all 5 domains of the quality of life questionnaire (physical, psychological, social, environmental, and environmental-Turkish), whereas women treated with hysterectomy experienced improvements in 3 domains (physical, environmental, and environmental-Turkish).

“This study shows that LNG-IUS is a promising conservative treatment alternative to hysterectomy,” Dr. Ozdegirmenci told Reuters Health by email. “Moreover, LNG-IUS seems to have superior effects on quality of life measures.”

Dr. Ozdegirmenci added, “We did not evaluate the effect of LNG-IUS on dysmenorrhea symptoms. Dysmenorrhea is also one of the major symptoms of adenomyosis, besides menorrhagia, so we plan to investigate the effect of LNG-IUS on dysmenorrhea as a future study.”